Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia.
Aust N Z J Obstet Gynaecol. 2021 Apr;61(2):258-262. doi: 10.1111/ajo.13288. Epub 2020 Dec 21.
Women with high-grade uterovaginal prolapse have a greater risk of recurrent prolapse after pelvic organ prolapse surgery. Royal College of Obstetricians and Gynaecologists guidelines have recommended sacrospinous suspension (sacrospinous fixation) at the time of vaginal hysterectomy, whenever there is a marked uterovaginal prolapse. We have modified the McCall culdoplasty by placing sutures extraperitoneally, higher and more lateral into the uterosacral/cardinal ligaments to re-support the vaginal cuff at the time of a vaginal hysterectomy.
To evaluate the results of a modified technique of McCall high culdoplasty and native tissue repair at time of vaginal hysterectomy in women with advanced uterovaginal prolapse.
Longitudinal clinical follow-up conducted between 2000-2018, in a tertiary urogynaecology centre for patients presenting with stage 3-4 uterovaginal prolapse, who underwent vaginal hysterectomy and modified McCall vault suspension.
There were 176 cases meeting the inclusion criteria. Mean follow-up was 19.35 months. There were 25 recurrences (14%) of ≥ stage 2 (76% not symptomatic). Twelve of these recurrences (48%) occurred in anterior compartment, six (25%) posterior, three (12%) combined anterior/posterior, two (8%) combined posterior/central and one case had recurrence in all compartments. Only six cases (3%) required another surgical procedure for symptomatic prolapse, all with an enterocele recurrence.
Our described modified McCall technique incorporates high extraperitoneal approach to apical resuspension along with closure of any existing large hiatal defects of the levator plate at the time of vaginal hysterectomy for advanced uterine prolapse has excellent outcomes and extremely low complication rates and avoids the need for sacrospinous fixation.
患有高级子宫阴道脱垂的女性在接受盆腔器官脱垂手术后复发脱垂的风险更高。皇家妇产科医师学院的指南建议在阴道子宫切除术中进行骶棘韧带悬吊术（骶棘固定术），只要存在明显的子宫阴道脱垂。我们通过在腹膜外更高级和更外侧放置缝线到子宫骶骨/主韧带中来修改 McCall 阔韧带修补术，以在阴道子宫切除术中重新支撑阴道袖口。
评估在高级子宫阴道脱垂患者的阴道子宫切除术中改良 McCall 高阔韧带修补术和天然组织修复的结果。
2000 年至 2018 年在一家三级泌尿妇科中心进行了纵向临床随访，对患有 3-4 期子宫阴道脱垂的患者进行了阴道子宫切除术和改良的 McCall 穹顶悬吊术。
符合纳入标准的有 176 例。平均随访时间为 19.35 个月。有 25 例（14%）复发≥2 期（76%无症状）。其中 12 例（48%）在前隔，6 例（25%）在后隔，3 例（12%）在前隔/后隔，2 例（8%）在后隔/中央隔，1 例在所有隔复发。只有 6 例（3%）因有症状的脱垂而需要再次手术，所有这些病例都有肠疝复发。
我们描述的改良 McCall 技术在阴道子宫切除术中用于高级子宫脱垂时，将高位腹膜外方法纳入到顶端悬吊术，并同时闭合提肛肌板的任何现有大裂孔，具有极好的效果，极低的并发症发生率，并避免了骶棘固定术的需要。
